CASE STUDY: ACUTE PYLENOPHRITIS DISEASE

I. INTRODUCTION:
Acute Pyelonephritis is a bacterial infection causing inflammation of the kidneys and is one of
the most common diseases of the kidney. It occurs as a complication of an ascending urinary
tract infection (UTI). Bacteria enter the body through the urethra and begin to multiply and
spread up to the bladder. From there, the bacteria travel through the bladder to the kidneys
and their collecting systems although it is unusual to develop a kidney infection, it can happen
— for instance, if you have an artificial joint or heart valve that becomes infected. Symptoms
usually include fever, flank pain, nausea, vomiting, burning on urination, increased frequency,
and urgency.
Pregnancy causes many temporary changes in the body, including physiological changes in the
urinary tract. Increased progesterone and increased pressure on the ureters can result in an
increased risk of pyelonephritis.
Pyelonephritis in pregnant women typically requires hospital admission. It can threaten the
lives of both mother and baby. It can also increase the risk of premature delivery. Pregnant
women are treated with beta-lactam antibiotics for at least 24 hours until their symptoms
improve.
To prevent pyelonephritis in pregnant women, a urine culture should be conducted between
the 12th and 16th weeks of pregnancy. A UTI that doesn’t have symptoms can lead to the
development of pyelonephritis. Detecting the UTI early can prevent kidney infection.

II. OBJECTIVES:
 Describe the population most at risk for pyelonephritis.
 Describe expected signs and symptoms in a patient with pyelonephritis.
 To provide health teaching to patient and the family regarding the disease condition,
the management, discharge teaching including the nutrition, hygiene, regular
medication and most especially the follow-up check-up.

III. PATIENT’S PROFILE:

Name: Ms. V
Age: 26 years old
Birth Date: May 16, 1994
Gender: Female
Marital Status: Single
Occupation: Housewife
Religion: Roman Catholic
Address: Brgy. Sabuanan, Sta. Lucia, Ilocos sur
Family Members:
 Rome Daniel Rafanan : Live in partner : 24 : Driver : High School Undergraduate
Renier Boncales : Relative of the Patient : 20 : student : Grade 12
Drexie Paula Billones : Daughter : 8 : Student : Grade 2
Danielle Maxime Rafanan : Daughter : 2 : Not yet schooling
Rome Daniel Rafanan II : Son : 10 months :
Date and time of admission:
LMP:
EDD:
GPTPAL:

IV. PAST AND PRESENT ILLNESS:

Ms.V is one of the Patient in our Barangay who have been suffering pyelonephritis to her
second baby 3 months in her womb . According to her statement, she does not know where
this disease began but she mentioned that she has a previous Urinary Tract Infection, wherein
this disease gets worse because she doesn’t drink enough water and she even drink a lot of soft
drinks that worsen the cycle of bacteria that can lead her to suffer in pyelonephritis disease.
Ms. V also mentioned that she was chilling cause of the extreme pain she fell beside her back,
she cannot stand by herself that even taking a bath her partner assists him, and she is in
terrible pain and have a hard time peeing. She diagnosed 8 months of her womb,

Present illness:

V. PHYSICAL ASSESSMENT:
ABNORMAL FINDINGS NORMAL FINDINGS ACTUAL FINDINGS

Head/Face (Skull, Scalp, -Androgenetic alopecia  Skull -Hair color is black.

and hair) (male or female pattern
baldness)
Alopecia areata.
a. Distribution and Scarring (cicatricial)
condition of hair:
alopecia.
Telogen effluvium.
b. Check scalp for Anagen effluvium.
bumps, nits, lesions, etc. Congenital hypotrichosis.
-bleeding, lesions, mases,
hematomas
c. Palpate skull for Cerebrospinal fluid (CSF)
tenderness leaks.
Cushing's disease.
Facial nerve disorders.
Meningioma.
Pituitary tumors.
Rathke's cleft cysts.
Trigeminal neuralgia.
- Generally round, with - The hair covered the
prominences in the frontal whole scalp.
and occipital area. -No evidence of Alopecia
- No tenderness noted upon (hair loss)
palpation.
- Hair is thin and smooth.
 Scalp
-Free from lice, nits, and
- Lighter in color than the
complexion.
dandruff
- Can be moist or oily. -Round with slight lump
- No scars noted. -No scars and lesions
- Free from lice, nits and -No tenderness upon
dandruff. palpation
- No lesions should be -The skin complexion is
noted. lighter.
- No tenderness or masses
on palpation.
 Hair
- Can be black, brown, or
burgundy depending on the
race.
- Evenly distributed covers
the whole scalp (No
evidence of Alopecia)
- Maybe thick or thin,
coarse, or smooth.
- Neither brittle nor dry.

Eyes, Eyebrow, and Unequal/absent movement
Eyelashes - nerve damage; scaling
with seborrhea
a. Eyebrows
b. Eyes squinting; groping with
hands - general
c. Eyelashes Absence – pulling or
plucking associated with OC
behavior
d. eyelids Lid lag - hyperthyroidism
-Incomplete closure creates
risk corneal damage
-Ptosis: drooping of upper
lid
-Periorbital edema, lesions
-Extropion - lower lid
dropping away
-Entropion- lower lid
turning in
e. Check state of Gonococcal conjunctivitis.
- Symmetrical and in line
with each other.
-Maybe black, brown, or
blond depending on race.
-Evenly distributed.
- Evenly placed and in line
with each other.
-None protruding.
-Equal palpebral fissure.
-Color dependent on
race.
-Evenly distributed.
-Turned outward.
-Upper eyelids cover the
small portion of the iris,
cornea, and sclera when
eyes are open.
-No PTOSIS noted.
(Drooping of upper
eyelids).
-Meets completely when
eyes are closed.
-Symmetrical.
-Both conjunctivae are
Separate thin eyebrows
Color is black.
Crossed eye or squint.
Color of her eyes is
Grayish black.
Distance between the
eyelids
Color is black, the lash is
thin. Her eyelashes are
long and straight.
-perfectly round and
symmetrical
-Completely meets when
eyes are closed.
Both eyes have pinkish
conjunctive -Neonatal chlamydial pinkish or red in color. color.
conjunctivitis. -With presence of many
minutes' capillaries.
-Pseudomembranous -Moist
conjunctivitis. -No ulcers
-Trachoma. -No foreign objects
f. Check Sclera - osteogenesis imperfecta -Sclerae is white in color -Sclera has white in
(brittle bone disease) and (anicteric sclera) actual color
Marfan's syndrome (a -No yellowish
connective tissue disorder). discoloration (icteric
sclera).
-Some capillaries may be
visible.
-Some people may have
pigmented positions.
g. Iris inflammation of the colored - The anterior chamber is On her naked eye, I only
part of your eye (iris). transparent. see the color of iris which
- No noted any visible is brown.
-eye pain, light sensitivity, materials.
headache, and decreased - Color of the iris depends
vision. on the person’s race
- severe vision loss and even (black, blue, brown or
green).
blindness. Infection, injury,
- From the side view, the
and autoimmune disease.
iris should appear flat
and should not be
bulging forward.
- There should be NO
crescent shadow casted
on the other side when
illuminated from one
side.
h. Pupils Anisocoria: unequal pupil - Equally round. Equally round
sizes. Horner's syndrome: - Constrict Pupils round with a
disruption of a nerve briskly/sluggishly when regular border, centered
pathway from the brain to light is directed to the in the iris
the one side of the face and eye, both directly and
that eye. consensual.
- Pupils dilate when
Third nerve palsy: one looking at distant objects
eyelid is completely closed, and constrict when
and that eye has moved looking at nearer objects.
outward and downward.

Ears Touching, wiggling, or
pulling on the outer ear
causes pain.
The ear canal is red, tender,
swollen, or filled with
yellowish green pus.
The eardrum is red and
bulging or looks dull and
-The earlobes are bean- -The earlobes have
shaped, parallel, and sticking out shape
symmetrical. - The same as the
-The upper connection of complexion and no
the ear lobe is parallel infection.
with the outer canthus of
the eye. Skin color is the same
-Skin is the same in color
as in the complexion.
 slightly pulled inward.
Size and shape.
Obvious bend or deformity:
a deviated nose is often
Nose best looked at from above.
Swelling.
Scars or abnormal creases.
Redness (evidence of skin
disease).
Discharge or crusting.
Offensive smell.
Mouth swelling, cyanosis, paleness,
dryness, sponginess,
Moistness and color of
bleeding or discoloration
lips
Teeth
Gums
-No lesions noted on
inspection.
- No lesions noted on
inspection.
The pinna recoils when
folded.
-Nose in the midline Nose is in midline.
-No Discharges.
-No flaring alae nasi. No tenderness
-Both nares are patent. No paranasal issues
-No bone and cartilage
deviation noted on
palpation.
-No tenderness noted on
palpation.
-Nasal septum in the
midline and not
perforated.
-The nasal mucosa is
pinkish to red in color.
(Increased redness
turbinates are typical of
allergy).
-No tenderness noted on
palpation of the
paranasal sinuses.
-With visible margin Upper and lower lips are
-Symmetrical in almost the same in
appearance and
thickness (Pouty lip)
movement
-Pinkish in color Reddish and black lip
-No edema White to yellowish color,
-No gum bleeding right canine, tooth is
-No receding gums
tartar and no pasta
-White to yellowish in
color No gums bleeding, and
-With or without dental pinkish color
caries and/or dental
fillings.
-With or without
malocclusions.
-No halitosis.
Neck Enlarge lymph nodes
-Focal thyroid lesion
-Thyroid cyst
-Thyroid calcification
-Enlarged Thyroid gland
-Hemangioma of the neck
- Asymmetry of the thyroid
lobes
Lungs and Thorax -Unilateral middle zone
abnormality
-The middle zones are
asymmetrical
-There is a small irregular
opacity on the right
-This opacity contains a dark -Absence of accessory
area - cavity
-Other areas of the lungs
are normal
Abdomen -abnormal growth in the
abdomen.
-visible swelling and may
change the shape of the
abdomen
-weight gain and symptoms -Contour may be flat,
such as abdominal
discomfort, pain, and
bloating
Extremities -Tenderness.
-Deformity.
-External skin changes such with prominences of
as erythema, ecchymosis,
abrasion, laceration, skin
tear, puncture wound,
scarring, or warmth.
-Foreign body (visible or
palpable)
-Joint instability, dislocation, and even.
subluxation, or laxity.
-The neck is straight. -The neck is straight
-No visible mass or -she has a goiter.
lumps.
-Symmetrical
-No jugular venous
distension (suggestive of
cardiac congestion).
-The neck is palpated just
above the suprasternal
note using the thumb
and the index finger.
-Regular breathing No respiratory issue
pattern The chest wall is
-Respiratory rate within symmetric, without
normal range for age deformity
-Chest expansion No tenderness is
symmetrical appreciated upon
-Absence of cyanosis or palpation of the chest
pallor wall.
Does not exhibit signs of
muscle use, retractions, respiratory distress.
and/or nasal flaring
-No pain or tenderness
with palpation. Skin
warm and dry; no
crepitus or masses
-Skin color is uniform, no Skin color is uniform
lesions.
-Some clients may have Abdomen is soft and
striae or scar. symmetric
-No venous There are no visible
engorgement. lesions or scars.
rounded or scaphoid non-tender without
-Thin clients may have distention
visible peristalsis.
-Aortic pulsation may be
visible on thin clients.
-Both extremities are Extremities are both
equal in size. equal in size
-Have the same contour
Color is even
joints. no tenderness or
-No involuntary deformity.
movements.
-No edema
-Color is even.
-Temperature is warm
and even.
-Has equal contraction
-Can perform complete
 -Decreased muscle strength range of motion.
or tone (ex. -No crepitus must be
noted on joints.

VI. ANATOMY AND PHYSIOLOGY OF THE ORGAN INVOLVED:

The urinary system's function is to filter blood and create urine as a waste by-product.
The organs of the urinary system include the kidneys, renal pelvis, ureters, bladder,
and urethra.

The body takes nutrients from food and converts them to energy. After the body has
taken the food components that it needs, waste products are left behind in the bowel
and in the blood.
The kidney and urinary systems help the body to eliminate liquid waste called urea,
and to keep chemicals, such as potassium and sodium, and water in balance. Urea is
produced when foods containing protein, such as meat, poultry, and certain
vegetables, are broken down in the body. Urea is carried in the bloodstream to the
kidneys, where it is removed along with water and other wastes in the form of urine.